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Research points to preventable conditions for rising health care costs

Author: Austin Ramsey, Owensboro Messenger

Author: Monday, October 24th, 2016

Many hospitalizations are preventable and may be to blame for the rising American health care costs, according to new research out of Western Kentucky University.

Several researchers in Bowling Green have found a link between access to primary care services and hospitalizations for preventable conditions such as diabetes, hypertension and asthma among Medicaid enrollees in comprehensive managed care plans.

Dr. William N. Mkanta, associate professor in the Department of Public Health at WKU, headed up the study published in the current edition of Health Services Research and Managerial Epidemiology.

Mkanta and his colleagues measured a sample of 25,581 Medicaid enrollees who received primary care services through managed care plans in 2009 in three large states intended to represent the West, South and Midwest regions of the nation for ethnic, racial, geographical and cultural diversity. Using the data, they assessed expenditures for hospitalizations and utilization expenditure differentials to determine factors associated with those preventable conditions, which are referred to as ambulatory care sensitive conditions, or ACSCs.

"Patients, providers and systems of care use information on inpatient service utilization on ACSC as a measure of quality for primary care services," Mkanta said.

Unfortunately, says Dr. Neale R. Chumbler, dean of the College of Health and Human Services, professor and co-researcher on the Medicaid research project, individuals are forgoing basic care due to access measures such as cost, location and employment until ACSCs develop into serious medical issues requiring hospitalizations. His research is one of few national studies applying an analytic approach to investigating ACSC hospitalizations in a Medicaid population, but he said he believes it points to a larger problem affecting most Americans on public or private health care plans.

"I think the big-picture message is that we're linking primary care to a hospital setting," Chumbler said. "ACSCs are managed in primary care settings day-in-and-day-out. But if people have those chronic conditions, and they aren't managed or monitored, they end up in hospitals and it gets extremely expensive.

"Many individuals are foregoing routine primary care visits because of costs," he said. "It's causing these bad outcomes downstream. What we need is more access to care and better strategies for self-management and self-care. We're not equipping patients well enough to manage their chronic conditions."

Diabetes was the most frequent ACSC, followed by heat disease, the study found. But among acute preventable conditions, urinary tract infections and dehydration were more common. A larger proportion of individuals hospitalized due to complications from these types of conditions required advanced treatment or died on admission. Overall mean expenditures were higher for those hospitalizations, too. The odds of ACSC-related hospitalizations were 30 percent higher among blacks and 25 percent higher among Hispanics, but age remained the primary predictor of such need for emergency department or long-term hospital care.

Chumbler said data used in the article was measured before President Barack Obama's health care law took effect, and there remain interesting implications on how such measures such as state-led Medicaid expansions may influence access to care, particularly in light of proposed changes among those expanded populations in states such as Kentucky. Access, he said, is multidimensional. It's not always financial, but can pertain to transportation and employer flexibility.

And even though Chumbler said he believes these issues extend beyond Medicaid populations, the implications already affect every American's pocketbook. Three-quarters of all hospital and insurance expenditures are derived from the top three ACS conditions measured -- diabetes, heart disease and hypertension. All of those conditions are preventable or at least highly manageable, Chumbler added.

"Information like this could have implications on lawmakers and policy decisions," he said. "It may influence them to deliver more higher quality care. What's interesting is that so many people have diabetes and hypertension and heart failure. So many Americans have these conditions and they are easily treatable through primary care. I think that this type of study could have implications on making that primary care more affordable and accessible."

Chumbler said he did not believe there was a measurable difference between managed care or pay for service Medicaid delivery systems, as it related to the results of the WKU research.

Just last week, the Foundation for a Healthy Kentucky released a study indicating that one in five Kentuckians between 18 and 65 delay or go without medical care due to cost. That accounts for almost 21 percent of all Kentucky adults, but the figures were almost 10 percent higher for Medicaid-eligible adults. The findings are based on a survey from earlier this year that asked people if cost had caused them to defer health care or medicine in the previous 12 months. It's part of an ongoing study on the impact of "Obamacare" by the State Health Access Data Assistance Center at the University of Minnesota.

Those results, Chumbler said, fall in line with his and his colleagues' research and pose troubling ramifications about the future of American health and the delivery of care.